Between orthopedic surgeons, chiropractors, physiatrists, neurosurgeons, and osteopathic physicians, it’s hard to know which doctor can best treat your pain.

Each approaches treatment from a different perspective. No treatment is guaranteed to give relief, so your choice will depend in part on your attitude toward the body and medicine—and your doctor’s own philosophy.

The back pain caregiver menu

Chiropractors
Chiropractors are often the go-to caregivers for back pain. In 2002, approximately 15 million Americans used chiropractic care, about 40 percent of them for low back pain. To become a Doctor of Chiropractic, students must complete four years of education and training at an accredited chiropractic college as well as a one-year internship. Be sure to choose a chiropractor who holds a board certification and is state licensed. Like osteopaths, chiropractors favor physical manipulation of the body, and chiropractic treatment focuses on manipulation of the spine. Be aware that some practitioners make greater claims about what they can cure than others. Choose a chiropractor who is honest about your chances of improvement.

Osteopathic physicians
Osteopathic physicians hold Doctor of Osteopathic Medicine (DO) degrees and their training is similar to that of MDs, though osteopathy puts more emphasis on whole-body treatment and musculoskeletal manipulation. Like MDs, they can write prescriptions and perform surgery.

Tension headaches
Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Not as severe as migraines, they are not usually accompanied by nausea and vomiting, and they rarely stop someone from continuing their regular activities. Over-the-counter treatments, such as aspirin, ibuprofen, or acetaminophen (Tylenol), are usually sufficient to treat tension headaches, which experts believe may be caused by contraction of neck and scalp muscles (including in response to stress), and possibly changes in brain chemicals.

Cluster headaches
Cluster headaches, which affect men more often than women, are recurring headaches that occur in groups or cycles. The headaches appear suddenly and are characterized by severe, debilitating pain on one side of the head often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face. During an attack, sufferers are often restless and unable to get comfortable and not likely to lay down the way someone with a migraine usually does. The cause of cluster headaches is unknown, but they may have some genetic component. There is no cure, but medications can reduce the frequency and duration of attacks.

Sinus headaches
When a sinus becomes inflamed, usually through an infection, it can cause pain. It usually comes with a fever, and can—if necessary—be diagnosed by MRI or CT scan (which can both detect changes in fluid levels), or by the presence of pus viewed through a fiber-optic scope. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.

Rebound headaches
Overuse of painkillers for headaches can, ironically, lead to rebound headaches. Culprits include over-the-counter medications like aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil), as well as prescription drugs.

“Most of the patients we see in a headache center with daily headache have medication-overuse, or rebound, headaches,” says Stewart Tepper, MD, director of research at the Center for Headache and Pain at the Cleveland Clinic Neurological Institute.

“They are on a merry-go-round and they can’t get off,” says Dr. Tepper. “They keep taking more medicine, they keep having more headaches, and so the patient becomes more and more desperate. That’s when they end up coming to headache specialists to kind of reset the whole system.”

One theory is that too much medication can cause the brain to shift into an excited state, triggering more headaches. Another is that the headaches are a symptom of withdrawal as the level of medicine drops in the bloodstream.

Migraine headaches
Migraine headaches come from a neurological disorder that can run in families and are defined by certain criteria.

• At least five previous episodes of headaches
• Lasting between four hours and 72 hours
• Having at least two out of four of these features: one-sided pain, throbbing pain, moderate-to-severe pain, and pain that interferes with, is worsened by, or prohibits routine activity
• Having at least one associated feature: nausea and/or vomiting, or, if those are not present, then sensitivity to light and sound

An oncoming migraine attack may, for some, be foreshadowed by an aura, which can include visual distortions (such as wavy lines or blind spots) or numbness of a hand. It’s estimated, though, that only 15% to 20% of migraineurs experience this.

As the temperatures begin to warm up in the Sunland area, the threat for the West Nile virus that thrives in hot weather increases, particularly in the months of August and September, according to Public Health Solutions District Health Department officials.

West Nile virus, which is transmitted to people through the bite of a mosquito that has picked up the virus from an infected bird, was reported in 163 people in 2007 and killed four people in Nebraska, according to the Nebraska Health and Human Services WNV surveillance program.

Gage and Jefferson counties each reported one case of WNV in 2007. Johnson, Pawnee and Saline counties had no reports of WNV in humans.

With the climax of WNV season still ahead, it is important to prevent the spread of WNV:

n Avoid the outdoors during dawn and dusk and mosquito-laden areas.

n If necessary, use insect repellent responsibly.

n Drain or fill in standing water pools on your property using natural substances, such as dirt, rocks and sand. Don’t forget about bird baths, pet dishes and toys in the yard.

n Remove or cover tire piles and make sure that no standing water is collecting on the cover. Cans, bottles, jars, buckets, drums and other containers should also be covered or emptied of standing water.

n Repair leaky pipes and outside faucets and move air conditioner drain hoses frequently. Eliminate puddles created by lawn-watering procedures.

n Spray mosquito roosting areas, usually found in leafy shade of shrubs, bushes, vines and flowers and in patches of tall grass and weeds.

There is no human vaccine for this virus, but early detection still provides the best chance for recovery. West Nile fever symptoms include fever and muscle weakness, according to PHS.

Meningitis, a complication of WNV, causes fever, headache, vomiting, stiff neck and a rash. West Nile encephalitis, another complication, causes disorientation, convulsions and paralysis.

While the majority of those infected with WNV do not develop West Nile fever, either of the complications can cause permanent damage or even death, particularly in immune-compromised patients.

PHS District Health Department has once again been collaborating with the Nebraska Health and Human Service System to conduct a surveillance program for West Nile virus.

By testing dead birds and mosquitoes, public health officials get an early indicator of the virus activity in the area and the risk to human beings of contracting the disease.

Dead bird collection began on May 31 and will continue through the end of October. If you find dead birds that meet the following criteria you should immediately contact the Public Health Solutions at 1-888-310-0565:

n The bird is a blue jay, crow, hawk or owl (these are the most common WNV carriers).

n The bird has been dead less than 24 hours (no maggots, sunken eyes, strong smell, etc.)

n The bird does not appear to have died from other causes (striking a car or window, being attacked by another animal, etc.)

If the bird is a suitable specimen, PHS personnel will arrange to pick it up and send it for testing. If it is not suitable, personnel will instruct you in safe disposal of the bird.

For more information about the surveillance project and about protecting yourself against West Nile virus, visit www.phsneb.org.

Portugal were knocked out of Euro 2008 by Germany last night and, true to his word, Cristiano Ronaldo finally began talking about his future.

The Portuguese dropped huge hints that he will be announcing his intention to move to Real Madrid in the next few days, as the Spanish champions have been publicly courting the player for several months.

The winger has long insisted it is his dream move, and though he maintained the transfer did not depend entirely on himself, if his decision is made, that could well be the turning point in the transfer saga.

Despite last night’s revelations, the club has moved to make an official statement on its website this morning denying that the player is for sale, or that the club will even listen to any offers for the 23-year-old.

“Further to Friday’s press speculation about where Cristiano Ronaldo’s future lies, the club has moved to reiterate its stance on the matter: United are not listening to offers,” read the statement.

“Ronaldo has continually been linked with a move to Spanish side Real Madrid this summer.

“However, the club reaffirmed its position to ManUtd.com on Friday morning. And the message is simple: the 23-year-old United star is ‘not for sale’.”

Notably, the club statement addresses the press speculation, but does not quote or mention the thoughts of the player himself.

Are things about to get ugly?

Penalties looked set to decide the destiny of the game when Ivan Klasnic made the most of a moment of madness from Recber Rustu with just three minutes of injury time remaining.

However, Semih Senturk converted with the final touch of the game to take it to penalties nonetheless.

Croatia never quite recovered from the blow as Ivan Rakitic and Luka Modric missed, and Rustu rounded it up with a fabulous save to send Turkey into the semi-final against Germany on Wednesday.

Neither side had ever faced a competitive penalty shootout before and the tension was palpable.

Luka Modric was to be first to try his luck, but fired his kick wide to the right. For the Turks, Arda Turan, the Galatasaray winger, then fired through Pletikosa to edge his side into a decisive lead.

Darijo Srna gave Croatia a hope to cling to with a well executed kick. The goalscorer, Semih Semturk was next up and made no mistake with a confident effort.

20-year-old Ivan Rakitic, who had hitherto enchanced his reputation at the tournament, then stroked his effort wide as the game slipped from Croatia’s grasp.

Hamit Altintop made it three from three for Fatih Terim’s side with a penalty that exuded coolness. Mladen Petric had to score to keep his side in the tie, but was denied by Rustu Recber.

The veteran atonted for his baffling extra-time error to put Turkey into the last four against Germany. Slaven Bilic will rue the inability of his two brightest charges to hit the target from twelve yards.

For Terim, his side take their place in the semi finals, despite leading matches in the tournament for a grand total of two minutes.

Line Ups:

Croatia (4-5-1): Pletikosa – Corluka, R Kovac, Simunic, Pranjic – N Kovac, Srna, Rakitic, Kranjcar (Petric 65’), Modric – Olic (Klasnic 101’). Subs not used: Galinovic, Runje, Simic, Vejic, Pokrivac, Knezevic, Vukojevic, Leko, Kalinic, Budan.

Turkey (4-4-2): Rustu – Sabri, Emre Asik, Gokhan Zan, Hakan Balta – Mehmet Topal (Senturk 76’), Arda Turan, Hamit Altintop, Tuncay – Nihat (Gokdeniz 117’), Kazim-Kazim (Ugur Boral 61’). Subs not used: Tolga Zengin, Servet Cetin, Gungor, Tumer Metin, Emre Belozoglu, Akman, Senturk.

Goals:

Croatia: Klasnic 118′

Booked:

Croatia:

Turkey: Tuncay, 27’, Arda Turan 49’, Ugur Boral, 89’, Emre Asik, 106’

Referee:

Roberto Rossetti (ITA)

Peter Staunton

more to follow..

That much, at least, can be shared about “The Happening,” a feature-length “Twilight Zone” episode in which a high school science teacher (Mark Wahlberg, constricted), his flighty wife (Zooey Deschanel of the big blue eyes), and an Innocent Little Girl in their care (Ashlyn Sanchez, nearly mute) face down an epidemic of death rampaging through the Northeast.

Supposedly, the cause of the catastrophe is unknown — it might be the work of terrorists, a virus, a toxin in the air, or the legacy of nuclear malfeasance. In fact, it’s a cinch for any moviegoer familiar with the post-”Sixth Sense” oeuvre of writer-director M. Night Shyamalan to diagnose the situation as an advancing case of crippling Shyamalania.

Some sure symptoms: The movie demonstrates a smart movie geek’s obsession with the rhythms and gory details of horror storytelling, undermined by a pompous insistence on spiritual lessons of the tritest kind (don’t be mean to Mother Nature! Trust in love!). And the filmmaker has fun with the cinematic conventions of social paranoia (all his most interesting minor characters with unusual faces are surely doomed) but is a sucker for overacting among his major players.

I don’t know what thespian virus is eating Betty Buckley as an ornery country loner, but I hope it’s not contagious.

It is a telling observation from a man whose incredible achievements on the football pitch were only slightly marred by explosions of rage that often seemed to be provoked by a perceived lack of respect from others.

“When you have 23 players (in a football team’s squad), everyone has their personality, one is stronger, one more shy, one more reserved, one more arrogant,” he tells CNN. “But the most important is respect between all of us.”

The French maestro, who hung up his boots two years ago, certainly enjoyed the respect of his teammates.

Former coaches and fellow players speak in reverent tones about him.

In large part, this is due to his sublime talent — few would argue with the summation that he was the most gifted footballer of his generation.

Yet this immense ability was accompanied by a shyness and humility notoriously absent among many of today’s top sportsmen, and by an intense professionalism that bordered on obsession.

Aimé Jacquet, the coach of the French national team that Zidane guided to victory in the 1998 thanks to two headed goals in the final against Brazil, says the player was gifted with “an internal vision.”

“He can make the ball do whatever he wants. But it is his drive which takes him forward. He is 100 per cent football,” he told the British newspaper The Guardian.

It was this dedication that allowed the French-born son of Algerian immigrants to escape his tough upbringing in a deprived suburb of Marseilles and make it on the big stage.

Starting out as a 17-year-old for French side Cannes, Zidane went on to play for Bordeaux, the Italian team Juventus and finished his career at a Real Madrid side packed with many of the world’s top talent.

Under the tenure of President Florentino Pérez the club made a host of big-name transfers including Portuguese international Luis Figo, Brazil star Ronaldo, Zidane and David Beckham.

Zidane says great teams need clear and defined leaders that the players can rally behind. At Real he identifies former teammate and current club captain Raúl González as such a player.

Nicknamed the Galácticos, the Madrid team frequently underperformed, however, under the sagging weight of expectation and an excess of big egos.

Zidane didn’t allow Real’s inconsistencies to hold him back, however. By the end his career, he had won almost every major honor in the game including the World Cup and European Championships with France and the crown of FIFA World Player of the Year a record three times.

In 2004, Forbes magazine named him the 42nd-highest paid athlete in the world, with earnings of $15.8 million a year.

“People tell me today, ‘yeah, it’s easy for you’ and I say no, because when I started no-one knew me. I had the skills of course but I made that path myself, and for everything you have to do that.”

And it is this same mental toughness that has allowed him to shrug off the taunts of the racists and emerge a national hero in a country whose immigrant community has enjoyed an uneasy relationship with the state.

Zizou, as he is known affectionately in France, has tried to stay above the murky world of race politics, only once being drawn into defending his Algerian heritage after a small-minded attack on his father’s war record.

This came after the World Cup win over Brazil, when a member of the far right political party the Front National suggested Zidane’s father was “a harki” — an Arabic word for Algerians who fought alongside the French in Algeria’s bloody independence struggle.

After a 2001 friendly match between France and Algeria had to be abandoned when angry young French Arabs invaded the pitch, Zidane was forced to break his silence, publically repudiating the libel.

He still seems reluctant to be turned into a spokesman for France’s North African community — he tells CNN he would prefer to be thought of as an “example” for immigrant children rather than as a hero.

Even so, his heritage is clearly something he remains deeply connected to. So that when he was famously sent off in the final of the 2006 World Cup after a headbutt on Italian defender Marco Materazzi in the last act of his career, it was an alleged slur against his family that provoked the attack.

The headbutt was shocking but not entirely unexpected. Throughout his career, Zidane was prone to flashes of temper on the pitch — he was sent off 14 times in his years as a professional footballer.

Nevertheless, it was an ignoble end for such a prodigious talent. Zidane has refused to apologise to Materazzi because he says that would be like condoning the Italian’s comments — exactly what Materazzi said is still in dispute, and two years on, he remains philosophical and largely unrepentent about the incident.

“When people say I shouldn’t have finished the World Cup on that note, I don’t look at it that way,” he says. “My career is much more than that moment.”

The Ancramdale resident died at a hospital in Hudson of complications from pneumonia, said his son, Martin Asinof.

Asinof was best known for Eight Men Out, his 1963 retelling of the “Black Sox” scandal in which eight members of the Chicago White Sox threw the 1919 World Series. He spent more than three years exhaustively researching the book, his son said.

The book was made into a 1988 movie by the same name starring John Cusack, Charlie Sheen and Christopher Lloyd.

The Manhattan native wrote more than a dozen books, included 1968′s Seven Days to Sunday, for which he spent a year traveling and living with the New York Giants football team. A novel, Final Judgment, is due to be published later this year, his son said.

Asinof was himself a minor-league ballplayer, briefly playing in the Philadelphia Phillies‘ organization before joining the Army and serving in World War II. Earlier this year, he completed a memoir about his wartime service, his son said.

“He was writing right up to the end,” Martin Asinof said of his father.

The elder Asinof also wrote for television and film, working on Western shows Maverick and Wagon Train, his son said.

During the McCarthy era, Asinof was blacklisted, and had to resort to writing under the names of other writers, his son said. Years later, after he obtained his FBI file, he told his son that he had been targeted because he once signed a petition outside of Yankee Stadium saying that black ballplayer Jackie Robinson should be allowed to play in the Major Leagues.

Asinof married Jocelyn Brando, the sister of actor Marlon Brando, after meeting when she was appearing on Broadway.

His parents met, Martin Asinof said, when his father was dating Rita Moreno, and the Brando siblings — who were starring in separate productions on Broadway at the time — joined them for dinner. Moreno and Marlon Brando left together, and the other two became smitten with each other. By 1955, they were divorced.

Usually, it’s the student who fails an exam. In Italy, it’s the exams that are getting failing grades for embarrassing errors that have already cost one education official her job.

Several mistakes were found in the English, ancient Greek and Italian exams high school students must pass before graduation.

The most error-riddled test was the English exam, given to students Thursday in vocational high schools, where foreign language courses are meant to prepare pupils for jobs in tourism.

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“I believe a waiter in Venice would use more adequate and correct English,” Sergio Perosa, an Italian expert on American and English literature, wrote in the Corriere della Sera newspaper Friday.

Italy’s new Education Minister Mariastella Gelmini vowed Friday that those responsible for the errors would be found and appropriate action taken against them.

Students and professors alike complained about a dropped word in an ancient Greek text given in high schools specializing in classical studies.

Earlier in the week, students emerging from an Italian literature exam found it amusing that a question about a poem by the Nobel laureate Eugenio Montale confused the inspiration for the work — the exam said the muse was a woman instead of a male ballet dancer.

That error cost Education Ministry official Caterina Petruzzi her job supervising the preparation of exams for Italy’s students.

Petruzzi insisted the test was correct, telling Sky TG24 TV that she received no complaints from teachers who had reviewed it before the students took the exam. She told Corriere della Sera she would get a job teaching at a private Italian university.
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